Rural Ethics and Mental Health: An Overview for Rehabilitation Counselors

Aims and methodMental Health Recovery Star is a multifaceted 10-item outcomes measure and key-working tool that has been widely adopted by service providers in the UK. We aimed to explore its factorial validity, internal consistency and responsiveness. Recovery Star readings were conducted twice with 203 working-age adults with moderate to severe mental health problems attending a range of mental health services, and a third time with 113 of these individuals.ResultsMental Health Recovery Star had high internal consistency and appeared to measure an underlying recovery-oriented construct. Results supported a valid two-factor structure which explained 48% of variance in Recovery Star ratings data. Two Recovery Star items (‘relationships’ and ‘addictive behaviour’) did not load onto either factor. There was good statistically significant item responsiveness, and no obvious item redundancy. Data for a small number of variables were not normally distributed and the implications of this are discussed.Clinical implicationsRecovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services and indicates that items relating to addictive behaviour, responsibilities and work could be further developed in future.

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Novel research on transition from child to adult mental health services in Europe: The MILESTONE project

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.942 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S58-S59 ◽

Cited By ~ 1

Author(s):

H. Tuomainen ◽

S.P. Singh ◽

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Service Providers ◽

Care Pathway ◽

Controlled Trial ◽

Ethical Challenges ◽

Adult Mental Health ◽

Related Service ◽

Competing Interest

IntroductionCurrent service configuration of distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS) is considered the weakest link where the care pathway should be most robust. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge for the EU.ObjectivesThe overall objective of the MILESTONE project is to improve transition from CAMHS to AMHS in diverse healthcare settings in Europe.AimsTo improve the understanding of current transition-related service characteristics, and processes, outcomes and experiences of transition from CAMHS to AMHS using a bespoke suite of measures; to explore the ethical challenges of providing appropriate care to young people as they move to adulthood; to test a model of managed transition in a cluster randomized controlled trial (cRCT) for improving health, social outcomes and transition to adult roles; and to develop training modules for clinicians and policy guidelines.MethodsData will be collected via systematic literature reviews; bespoke surveys to CAMHS professionals, experts and other stakeholders; focus groups with service providers and users and members of youth and mental health advocacy groups; and a longitudinal cohort study with a nested cRCT in eight EU countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS service users, their parents/carers, and clinicians, with assessments at baseline, 9, 18 and 27 months.ResultsFirst results are expected in 2016 with further major findings following in 2019.ConclusionsThe MILESTONE project will provide unprecedented information on the nature and magnitude of problems at the CAMHS-AMHS interface, and potential solutions to overcome these.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Benchmarking Australia's mental health services: is it possible and useful?

Australian Health Review ◽

10.1071/ah070623 ◽

2007 ◽

Vol 31 (4) ◽

pp. 623 ◽

Cited By ~ 13

Author(s):

Tom J Meehan ◽

Terry J Stedman ◽

Ken E Neuendorf ◽

Irene D Francisco ◽

Malcolm G Neilson

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Service Providers ◽

Performance Data ◽

Service Performance ◽

Service Characteristics ◽

Evaluation Of Performance ◽

Health Service Providers ◽

Health Field

Background: Benchmarking of performance indicators in the mental health field is gaining currency in Australia as a strategy for improving service quality. Aim: To engage mental health service providers in the collection and evaluation of performance data. Methods: Three separate rounds of data collection involving high secure, extended treatment, and medium secure services were carried out between 2003 and 2005. Twenty-five core indicators were identified and these were used to assess service inputs, processes, outputs and outcomes. Results: Differences in casemix, clinical practice and local business rules gave rise to variation in service performance. The benchmarking exercise led to the implementation of quality improvement initiatives. Conclusions: It is possible and useful to collect and evaluate performance data for mental health services. While services appear similar enough to benchmark, information related to both casemix and service characteristics needs to be included in benchmarking data to understand the factors that produce differences in service performance.

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Depression/Bipolar Peer Support Groups: Perceptions of Group Members about Effectiveness and Differences from Other Mental Health Services

The Qualitative Report ◽

10.46743/2160-3715/2017.2964 ◽

2017 ◽

Author(s):

Joe Behler ◽

Allen Daniels ◽

Jennifer Scott ◽

Lewis Mehl-Madrona

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Peer Support ◽

Support Groups ◽

Service Providers ◽

Health Service Providers ◽

Important Addition ◽

Group Members ◽

Constant Comparative Analysis

Peer support services remain poorly understood by many mental health service providers. In this study we explored the views of people who use peer led support groups. We asked how adding peer support groups changed, balanced, or augmented the use of conventional mental health services. Participants were 43 adults attending 4 peer led support groups for depression/bipolar disorder. Data consisted of observations of all 43 participants interacting in their group, in-depth interviews of 20 participants, and results from 2 standardized questionnaires to ballpark the level of symptom severity relative to other groups. Through constant comparative analysis, 12 categories emerged. The most salient features of our findings consisted of the shared perception that groups promoted recovery and augmented conventional services. Members felt acceptance due to their shared diagnoses. Groups provided an experience of community in which recovery skills could be practiced, practical advice received, and hope and empowerment encouraged. Groups appeared to provide participants with important support and healing unavailable from psychotherapy and psychiatry. Peer support groups appeared to be an important addition and sometimes an adequate substitute for psychotherapy and/or psychiatry. Further research is indicated and quantitative students should build on the insights of qualitative studies in developing their protocols.

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Perspectives of Health Service Providers on Barriers to Accessing Perinatal Mental Health Services in Karnataka, India: a Qualitative Study

10.21203/rs.3.rs-122820/v1 ◽

2020 ◽

Author(s):

Debarati Mukherjee ◽

Nolita Dolcy ◽

Daisy A John ◽

Maithili Karthik ◽

Swapnil A Gadhave ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Mental Health Services ◽

Health Services ◽

Service Providers ◽

Maternal Mental Health ◽

Perinatal Mental Health ◽

Frontline Workers ◽

Individual Level ◽

Health Service Providers

Abstract Background: Poor maternal mental health is a major public health concern since it adversely impacts both maternal and child health outcomes. This study aimed to document the barriers to utilizing perinatal mental health services in Karnataka, India, and to determine its relationship with risk factors of poor maternal mental health in this context. Methods: Qualitative research methods using in-depth interviews were conducted on twenty-one local stakeholders who represented health service providers in various capacities: mental health specialists (n = 4), gynaecologists (n = 2), government officials from the Department of Health and Family Welfare (n = 2), and Department of Women and Child Development (n = 2), senior state consultant to United Nations Children’s Fund (n = 1), and frontline workers (n = 10). Data were analysed using a thematic framework analysis approach. Results: We identified multiple barriers to service utilization operating at the levels of the health system, community, family, and the individual. Health-system level barriers included lack of a universal screening mechanism, poor infrastructure, poor training of frontline workers on mental health issues, and inadequate time for counselling and treatment. Community-level barriers included stigma and misconceptions, leading to a lack of social support. Family and individual level barriers included the financial burden of availing services, lack of family and partner support, and lack of empowerment and motivation in the woman to seek services. Family and individual level barriers interacted with risk factors of poor maternal mental health. Based on this evidence and drawing from the literature, we propose a contextualised, stepped-care model for universal screening, detection, referral, and treatment of women with perinatal mental health conditions for Karnataka that is integrated with the reproductive, maternal, and child health (RMNCH) program in primary care settings. Conclusions: The framework developed in this study suggests that addressing the identified barriers would potentially increase uptake of available services, create awareness about and demand for high-quality mental health services, reduce the risk factors of poor maternal mental health, and eventually improve our understanding of its true burden in the state of Karnataka. This is essential for proper implementation, monitoring, and evaluation of programs relevant to perinatal mental health.

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Mental Health Services for Older Adults in Rural Areas: An Ecological Systems Approach

Journal of Applied Gerontology ◽

10.1177/0733464807311646 ◽

2008 ◽

Vol 27 (3) ◽

pp. 252-266 ◽

Cited By ~ 15

Author(s):

Gregory F. Sanders ◽

Margaret A. Fitzgerald ◽

Marlys Bratteli

Keyword(s):

Mental Health ◽

Older Adults ◽

Mental Health Services ◽

Health Services ◽

Focus Groups ◽

Rural Areas ◽

Service Providers ◽

Ecological Systems ◽

Care Providers ◽

Focus Group Study

Groups of North Dakota professionals from health and aging services participated in a focus group study of mental health needs and barriers to service among older adults. Data were collected from 13 focus groups that included human service providers, public health nurses, out-reach workers, and advisory groups who discuss mental health and aging issues in a number of ecological systems contexts. Lack of knowledgeable care providers, funding cutbacks, accessibility of services, and ageism were frequently cited barriers to mental health services for older adults in rural areas. Focus groups also discussed the needs of older adults including information on services, how to access services, the need for service providers in rural areas, and routine assessments by physicians. Participants suggested that the main needs of providers were education, more services, and changes or flexibility in the types of services.

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Self-identified barriers to rural mental health services in Iowa by older adults with multiple comorbidities: qualitative interview study

BMJ Open ◽

10.1136/bmjopen-2019-029976 ◽

2019 ◽

Vol 9 (11) ◽

pp. e029976 ◽

Cited By ~ 2

Author(s):

Lauren Elizabeth Pass ◽

Korey Kennelty ◽

Barry L Carter

Keyword(s):

Mental Health ◽

Older Adults ◽

Mental Health Services ◽

Health Services ◽

Rural Areas ◽

Service Providers ◽

Mental Healthcare ◽

Chronically Ill ◽

Healthcare Services ◽

Qualitative Interview Study

ObjectivesIndividuals in rural areas face critical health disparities, including limited access to mental healthcare services and elevated burden of chronic illnesses. While disease outcomes are often worse in individuals who have both physical and mental comorbidities, few studies have examined rural, chronically-ill older adults’ experiences accessing mental health services. The aim of the study was to determine barriers to finding, receiving and adhering to mental health treatments in this population to inform future interventions delivering services.DesignWe conducted a qualitative study of barriers and facilitators to mental healthcare access. 19 interviews were analysed deductively for barriers using a modified version of Penchansky and Thomas’s theory of access as an analytical framework.SettingThis study was conducted remotely using telephonic interviews. Patients were located in various rural Iowa towns and cities.Participants15 rural Iowan older adults with multiple physical comorbidities as well as anxiety and/or depression.ResultsWe found that while patients in this study often felt that their mental health was important to address, they experienced multiple, but overlapping, barriers to services that delayed care or broke their continuity of receiving care, including limited knowledge of extant services and how to find them, difficulties obtaining referrals and unsatisfactory relationships with mental health service providers.ConclusionsOur findings indicate that intervention across multiple domains of access is necessary for successful long-term management of mental health disorders for patients with multiple chronic comorbidities in Iowa.

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Perspectives of Health Service Providers on Barriers to Accessing Perinatal Mental Health Services in Karnataka, India: A Qualitative Study

10.21203/rs.3.rs-183820/v1 ◽

2021 ◽

Author(s):

Debarati Mukherjee ◽

Nolita Dolcy ◽

Daisy A John ◽

Maithili Karthik ◽

Swapnil A Gadhave ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Mental Health Services ◽

Health Services ◽

Service Providers ◽

Maternal Mental Health ◽

Perinatal Mental Health ◽

Frontline Workers ◽

Individual Level ◽

Health Service Providers

Abstract Background: Poor maternal mental health is a major public health concern since it adversely impacts both maternal and child health outcomes. This study aimed to document the barriers to utilizing perinatal mental health services in Karnataka, India, and to determine its relationship with risk factors of poor maternal mental health in this context. Methods: Qualitative research methods using in-depth interviews were conducted on twenty-one local stakeholders who represented health service providers in various capacities: mental health specialists (n = 4), gynaecologists (n = 2), government officials from the Department of Health and Family Welfare (n = 2), and Department of Women and Child Development (n = 2), senior state consultant to United Nations Children’s Fund (n = 1), and frontline workers (n = 10). Data were analysed using a thematic framework analysis approach. Results: We identified multiple barriers to service utilization operating at the levels of the health system, community, family, and the individual. Health-system level barriers included lack of a universal screening mechanism, poor infrastructure, poor training of frontline workers on mental health issues, and inadequate time for counselling and treatment. Community-level barriers included stigma and misconceptions, leading to a lack of social support. Family and individual level barriers included the financial burden of availing services, lack of family and partner support, and lack of empowerment and motivation in the woman to seek services. Family and individual level barriers interacted with risk factors of poor maternal mental health. Based on this evidence and drawing from the literature, we propose a contextualised, stepped-care model for universal screening, detection, referral, and treatment of women with perinatal mental health conditions for Karnataka that is integrated with the reproductive, maternal, and child health (RMNCH) program in primary care settings. Conclusions: The framework developed in this study suggests that addressing the identified barriers would potentially increase uptake of available services, create awareness about and demand for high-quality mental health services, reduce the risk factors of poor maternal mental health, and eventually improve our understanding of its true burden in the state of Karnataka. This is essential for proper implementation, monitoring, and evaluation of programs relevant to perinatal mental health.

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